Transvenous Dual-Chamber Pacemaker Implantation in a Patient with Persistent Left Superior Vena Cava Undergoing Maintenance Hemodialysis.

Abstract

Background: Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly. Permanent pacemaker implantation (PPI) in patients with PLSVC presents challenges in placing both the right ventricular and atrial leads. The article describes a technique for dual-chamber PPI using standard leads in a PLSVC patient with chronic kidney disease on maintenance hemodialysis.

Case presentation: A 69-year-old male patient with sick sinus syndrome (SSS), hypertension, moderate mitral regurgitation, dilated left ventricle, diabetes, chronic kidney disease (on hemodialysis), and NYHA III heart failure underwent dual-chamber pacemaker implantation via the left axillary vein. Venography revealed a persistent left superior vena cava, a challenge for the placement of leads. The ventricular lead was positioned in the right ventricular outflow tract using a Biotronik active fixation lead with a "C" shaped stylet, and the atrial lead was placed in the right atrial lateral wall. The procedure took 115 minutes with 17.5 minutes of fluoroscopy. After 4 months, the patient showed symptom improvement and stable pacing parameters.

Conclusion: Dual chamber pacemaker implantation through PLSVC in a patient undergoing maintenance hemodialysis using a "C" shaped stylet technique is feasible, safe, and effective.